Can You Take Suboxone Daily While Using Methamphetamine?
Yes, you can and should continue taking Suboxone (buprenorphine/naloxone) daily even if you are using methamphetamine, because discontinuing buprenorphine precipitates opioid withdrawal and dramatically increases your risk of relapse to more dangerous opioids and overdose death. 1
Why Suboxone Should Be Continued
Buprenorphine maintenance therapy saves lives by preventing relapse to illicit opioids (such as heroin or fentanyl), which carry far higher overdose mortality than methamphetamine use. 1
There is no pharmacologic contraindication to taking buprenorphine while using stimulants like methamphetamine—the two drug classes act on completely different receptor systems (opioid receptors versus dopamine/norepinephrine systems). 2
Stopping buprenorphine to address methamphetamine use is counterproductive because it removes the protective effect against opioid relapse without treating the stimulant problem. 1
Managing Concurrent Stimulant Use
Address methamphetamine use separately through behavioral interventions (cognitive-behavioral therapy, contingency management) and psychosocial support, while maintaining the buprenorphine regimen. 1
Screen for and treat co-occurring psychiatric conditions (depression, anxiety, ADHD) that may be driving methamphetamine use, as these are common in patients with polysubstance use. 1
Increase monitoring frequency with weekly or biweekly visits during active methamphetamine use to provide closer clinical oversight and harm-reduction counseling. 1
Safety Considerations Specific to This Combination
QT-interval prolongation risk: Both buprenorphine and methamphetamine can prolong the QT interval; obtain a baseline ECG and avoid other QT-prolonging medications (certain antipsychotics, antibiotics, antiarrhythmics). 2, 3
Cardiovascular monitoring: Methamphetamine causes tachycardia and hypertension; check vital signs at each visit and refer for cardiology evaluation if chest pain, palpitations, or syncope occur. 2
Avoid serotonergic combinations: Methamphetamine has serotonergic activity; combining it with buprenorphine plus other serotonergic agents (SSRIs, SNRIs, tramadol) raises the theoretical risk of serotonin syndrome—monitor for agitation, hyperthermia, tremor, and hyperreflexia. 2
Standard Buprenorphine Dosing Remains Unchanged
Maintain the standard 16 mg daily dose (range 4–24 mg) that was effective before methamphetamine use began; do not reduce the buprenorphine dose in response to stimulant use. 1, 4
Once-daily dosing is preferred over split dosing (e.g., 8 mg twice daily), as once-daily administration is associated with fewer opioid relapses and more negative urine drug screens. 5
Harm-Reduction Measures
Provide take-home naloxone kits at every visit, because polysubstance use (especially if opioids are reintroduced) increases overdose risk. 1
Offer hepatitis C and HIV screening routinely, as injection methamphetamine use and sexual risk behaviors associated with stimulant use elevate transmission risk. 1
Counsel on safer use practices if the patient continues methamphetamine use (avoid injection, use clean supplies, stay hydrated, avoid mixing with other depressants). 1
Common Pitfalls to Avoid
Do not discontinue or taper buprenorphine in an attempt to "simplify" treatment or because the patient is using other substances—this removes the life-saving protection against opioid overdose. 1
Do not withhold buprenorphine refills as punishment for positive methamphetamine urine screens; this punitive approach drives patients away from care and increases mortality. 1
Do not assume methamphetamine use indicates buprenorphine treatment failure—polysubstance use is common, and buprenorphine specifically treats opioid use disorder, not stimulant use disorder. 1